Should we perform an echocardiogram in hypertensive patients classified as having low and medium risk?

Suárez, C. Roldán; Villar, José R.; Martel, Nieves; Extremera, Blas Gil; Suliman, Najaty; Campo, Carlos; Castellanos, V.; Liébana, A; Rodilla, Enrique; Nieto, Javier; Velasco, Olga; Ruilope, Luís M.

doi:10.1016/j.ijcard.2004.12.076

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…In concordance with this statement, our study results showed that conventional voltage criteria did not reliably predict different LV geometry patterns. Our findings related to ECG voltage criteria support and shed light on Suarez et al [22] suggestions that echo should be done almost in every patient given the low sensitivity and unreliability of conventional ECG voltage criteria. Echocardiography is currently a more important and useful tool in predicting LV mass and geometry as well as cardiac status than ECG.…”

Section: Discussionsupporting

confidence: 86%

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Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension

Aktöz

Erdoğan

Altun

2007

International Journal of Cardiology

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Section: Discussionsupporting

confidence: 86%

“…Suarez et al [22] emphasized the value and reliability of echocardiography over ECG in predicting abnormal LV geometry. They also stressed the importance of echo that should be routinely done in every patient diagnosed with hypertension whether they are at low or medium risk.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension

Aktöz

Erdoğan

Altun

2007

International Journal of Cardiology

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“…This is important because SHHD is a meaningful point where intervention can prevent potential life‐threatening conditions . However, for many with HTN, especially African Americans in underserved communities, heart disease will not be detected until advanced stages, limiting options for secondary or even tertiary prevention . While no one would suggest that ED physicians assume primary responsibility for the management of SHHD, in settings similar to ours where SHHD is likely to be prevalent, it is reasonable for the ED to play an active role in screening and referral.…”

Section: Discussionmentioning

confidence: 96%

Screening and Treatment for Subclinical Hypertensive Heart Disease in Emergency Department Patients With Uncontrolled Blood Pressure: A Cost‐effectiveness Analysis

Twiner

Marinica

Kuper

et al. 2017

Academic Emergency Medicine

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Objectives Poorly controlled hypertension (HTN) is extremely prevalent and, if left unchecked, subclinical hypertensive heart disease (SHHD) may ensue leading to conditions such as heart failure. To address this, we designed a multidisciplinary program to detect and treat SHHD in a high-risk, predominantly African American community. The primary objective of this study was to determine the cost-effectiveness of our program. Methods Study costs associated with identifying and treating patients with SHHD were calculated and a sensitivity analysis was performed comparing the effect of four parameters on cost estimates. These included prevalence of disease, effectiveness of treatment (regression of SHHD, reversal of left ventricular hypertrophy [LVH], or blood pressure [BP] control as separate measures), echocardiogram costs, and participant time/travel costs. The parent study for this analysis was a single-center, randomized controlled trial comparing cardiac effects of standard and intense (<120/80 mm Hg) BP goals at 1 year in patients with uncontrolled HTN and SHHD. A total of 149 patients (94% African American) were enrolled, 133 (89%) had SHHD, 123 (93%) of whom were randomized, with 88 (72%) completing the study. Patients were clinically evaluated and medically managed over the course of 1 year with repeated echocardiograms. Costs of these interventions were analyzed and, following standard practices, a cost per quality-adjusted life-year (QALY) less than $50,000 was defined as cost-effective. Results Total costs estimates for the program ranged from $117,044 to $119,319. Cost per QALY was dependent on SHHD prevalence and the measure of effectiveness but not input costs. Cost-effectiveness (cost per QALY less than $50,000) was achieved when SHHD prevalence exceeded 11.1% for regression of SHHD, 4.7% for reversal of LVH, and 2.9% for achievement of BP control. Conclusions In this cohort of predominantly African American patients with uncontrolled HTN, SHHD prevalence was high and screening with treatment was cost-effective across a range of assumptions. These data suggest that multidisciplinary programs such as this can be a cost-effective mechanism to mitigate the cardiovascular consequences of HTN in emergency department patients with uncontrolled BP.

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“…A 12-lead ECG is standard for the assessment of all hypertensive patients. 5,6 Early diagnosis of DD is crucial and ECG criteria may be of clinical value.…”

mentioning

confidence: 99%

Ventricular Activation Time as a Marker for Diastolic Dysfunction in Early Hypertension

Boles

Almuntaser

Brown

et al. 2010

American Journal of Hypertension

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Should we perform an echocardiogram in hypertensive patients classified as having low and medium risk?

Cited by 11 publications

References 30 publications

Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension

Electrocardiographic prediction of left ventricular geometric patterns in patients with essential hypertension

Screening and Treatment for Subclinical Hypertensive Heart Disease in Emergency Department Patients With Uncontrolled Blood Pressure: A Cost‐effectiveness Analysis

Ventricular Activation Time as a Marker for Diastolic Dysfunction in Early Hypertension

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